2023 AtlantiCare Benefits Booklet

Life Insurance

TABLE OF CONTENTS WELCOME.................2 WHAT’S NEW. ...........3 SERVICE CENTERS AND WEBSITES..........4 HOW TO ENROLL....5-6 MEDICAL..............7-14 PRESCRIPTION DRUG. ................15-17 ADDITIONAL MEDICAL PLAN RESOURCES........18-22 DENTAL...............23-24 VISION.....................25 LIFECENTER..............26 LIFE INSURANCE. .....27 DISABILITY...............28 VOLUNTARY OFFERINGS. ........29-32 SPENDING ACCOUNTS. ............33 RETIREMENT BENEFITS..................34 WELLNESS. .........35-38 LEGAL NOTICES...39-41 GLOSSARY..........42-43 FAQs...................44-46 CONTACTS.........47-48 FORMS................49-58

! IMPORTANT

As a full-time employee you automatically receive, at no cost, basic group term life insurance and AD&D insurance benefits in the amount of 1.5 times your base annual salary. Coverage takes effect the first day of the month following your date of hire/full time eligibility status. You may elect supplemental life insurance when you are first eligible with no medical questions asked. If you request a change during open enrollment, you will be required to complete a medical questionnaire known as a Statement of Health (SOH) / Evidence of Insurability (EOI). Company-provided basic group term life insurance coverage is a tax-free benefit up to $50,000. If your coverage exceeds $50,000, the IRS considers this amount taxable as “imputed income.” This does not represent a deduction from your pay but will be reported as taxable income on your annual W-2. “Imputed income” will appear on your pay stub under the heading of “Group Term Life.” This coverage is age-based. The amount of your Life and AD&D Insurance Benefits will reduce on the first day of the month following your 70th birthday. The terms, conditions, limitations, and exclusions of coverage are set forth in the group policy (“Policy”) between the Company and the Insurer. In the event of any conflict between this Employee Handbook (or any Summary Plan Description) and the Policy, the Policy shall govern. ? DID YOU KNOW? You can retrieve the SOH/EOI Form through the Forms & Plan Documents tile on the AtlantiCare Benefits Enrollment/Service Site. You will have 60 days to complete and submit the document. Your additional coverage amount must be approved by the carrier prior to taking effect. You will not see a payroll deduction for the additional amount until coverage is approved.

Designate a beneficiary. Your beneficiary is the person(s) who will receive your life insurance benefits payment upon your death. Designate, update or view your beneficiary at myadp.com .

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